| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,264 |
2,114 |
$198K |
| 92014 |
|
1,828 |
1,718 |
$129K |
| 92250 |
|
2,718 |
2,530 |
$112K |
| 92060 |
|
1,954 |
1,809 |
$67K |
| 92083 |
|
1,258 |
1,207 |
$53K |
| V2025 |
Deluxe frame |
1,458 |
1,390 |
$39K |
| 67938 |
|
1,257 |
968 |
$28K |
| 92012 |
|
749 |
612 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,097 |
1,209 |
$22K |
| V2020 |
Frames, purchases |
512 |
503 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
861 |
820 |
$11K |
| 99204 |
|
184 |
153 |
$9K |
| 92015 |
|
944 |
883 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
664 |
431 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
103 |
64 |
$1K |
| 92025 |
|
14 |
13 |
$314.80 |
| 92273 |
|
16 |
12 |
$284.57 |
| V2750 |
Anti-reflective coating, per lens |
15 |
13 |
$235.20 |
| 92285 |
|
36 |
32 |
$184.96 |